Payment Policy

Copays and anticipated patient portion of all fees for services provided (cost share and deductible) are collected at the time services are rendered.

After each appointment, we will submit all charges to your insurance for payment. Once insurance payment has been received, you will receive a billing statement from our office indicating whether any remaining balance is due. Insurance companies will deny payment if any information is not current. They will also deny payment if information is not submitted correctly within a certain amount of time. Please notify us of any changes in insurance, address or phone numbers. We will ask you about such changes at each clinic visit.

Many of our services are one-on-one (i.e., no double-booking); which means missed appointments are lost revenue for the office and missed opportunities for other patients to be treated when needed. A charge of $40 will be applied for appointments that are not cancelled or rescheduled with at least 24 hours notice.

Insurance Plans

We cannot accept HMO insurance plans. We are contracted providers (in network) with many PPO health plans. Please contact your insurance directly to be certain that Orthopedic Surgery San Diego is in your provider network. In so doing, please verify coverage and discuss your benefits, co-insurance, and deductible. Unfortunately, we are unable to answer questions regarding such coverage and will direct you back to your insurance carrier. As contracted providers with insurance plans, we have agreed to accept certain payment amounts for most services that we provide. The provider cannot waive copayments, deductibles, coinsurance or other amounts you are responsible to pay under your health plan.

Out-of-Network Insurance

You have the right to use a participating or nonparticipating provider for your care. You have the right to use a participating provider and your in-network benefits for the entire in-office treatment.

If we are not contracted with your PPO insurance, we can still provide medical care to you and your family as out-of-network providers. This means that we don’t have predetermined negotiated rates for services with your carrier. If that is the case, your fees will be on-par with what many insurance carriers pay for in-network services. We encourage you to contact your insurance carrier to determine your plan’s out-of-network benefits, to see what they will cover. We are happy to bill your insurance, but you are ultimately responsible for all charges incurred regardless of insurance payment. As with all out-of-network providers, there will be a difference between our charges and the amount that your insurance pays. Any balance remaining after insurance payment is due from you within 30 days. Keep in mind that this balance payment and all treatment we recommend will be eligible for reimbursement from health savings or flexible spending accounts.

No Insurance

We also welcome families with HMO or those choosing not to use medical insurance. Payment is due at time of service. We accept cash, Mastercard, Visa, American Express, and personal check. For any billing questions, please call (760) 573-4411 or email billing@orthopedicsurgerysandiego.com.

Worker’s Compensation Injury

For anyone who has suffered a workplace injury, getting quality medical treatment is a top priority. The injured worker has the right to change treating doctors under certain circumstances.

In California, if your employer offers group health coverage, you have the right to “predesignate” a doctor to treat you for work-related injuries. However, the doctor must be your primary care physician with whom you have a history of treatment, and you must give written notice of your predesignation to your employer before your work-related injury. If you didn’t predesignate a doctor, and your employer has established a medical provider network (MPN), you’ll probably have to select a doctor through this network.

Your treating doctor will play a crucial role in your workers’ comp case and will make several important decisions, including requesting treatment, whether you need time off from work, and whether you have any permanent disability for which you should be compensated. Because of this, it’s important that you feel comfortable with your doctor and the decisions he or she is making. If at any point you strongly disagree with your doctor’s opinions about your care or future work restrictions, you may want to consider switching doctors. The process for changing your doctor depends on how your initial doctor was selected.

If you predesignated a physician, you will have the most freedom to switch doctors. You can do so at any time by giving notice to your employer’s insurance company. There’s no waiting period, and there’s no limit on the number of times you can change doctors.

If your employer has an MPN, you’ll have less freedom to switch doctors. If you are not satisfied with the first doctor you selected through the MPN, you can ask to switch doctors at least twice. However, the second and third doctors must also be selected through the MPN.

If your employer initially selected a specific doctor or health care group for you, you can select your own doctor after 30 days (there may be exceptions to this rule). This waiting time period applies when you want to change to a doctor who is outside of the health care group designated by your employer. However, you can always request to switch doctors within the health care organization before these waiting periods are up. Within five days of your request, the health care organization must provide you with a list of participating doctors to choose from.

If your employer doesn’t have an MPN, you can also make a one-time request to change physicians at any time, for any reason. However, if the insurance company acts within five days of your request, it gets to select your new doctor.

To make your request for a change of treating doctors, you can notify the insurance company orally or in writing. However, the best practice is to always put such requests in writing. You can write a letter to the insurance company, or if you call the insurance company, be sure to follow up with written confirmation.